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Research ArticleIMAGING

Risk Stratification in Heart Failure Using 123I-MIBG

Geoffrey M. Currie, Basit Iqbal, Janelle M. Wheat, Lexin Wang, Marko Trifunovic, Herbert F. Jelinek and Hosen Kiat
Journal of Nuclear Medicine Technology December 2011, 39 (4) 295-301; DOI: https://doi.org/10.2967/jnmt.111.088369
Geoffrey M. Currie
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Basit Iqbal
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Janelle M. Wheat
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Lexin Wang
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Marko Trifunovic
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Herbert F. Jelinek
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Hosen Kiat
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  • FIGURE 1.
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    FIGURE 1.

    Anterior planar images demonstrating global accumulation of 123I-MIBG in myocardium at 15 min (A) and 4 h (B) after injection. Standard global regions of interest are red; modified regions of interest are blue. Lung and liver regions are purple. Images highlight need for greater discriminatory power using SPECT. Nonetheless, H:M ratio is on order of 2, and washout is marked at 4 h.

  • FIGURE 2.
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    FIGURE 2.

    Polar map demonstrating regional cardiac 123I-MIBG distribution at 15 min (left) and 4 h (right) after intravenous administration. Arrows highlight areas of denervation that correspond to similar regions of hypoperfusion on end-diastolic polar map in 99mTc-MIBI study (Fig. 3) but show thickening and motion (Fig. 4).

  • FIGURE 3.
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    FIGURE 3.

    Polar map demonstrating regional myocardial perfusion (%) at end-diastole (A) and end-systole (B). Perfusion deficits are seen in inferior and inferolateral walls. Arrows highlight areas of decreased perfusion in distal left anterior descending region that correspond to similar regions of 123I-MIBG denervation (Fig. 3).

  • FIGURE 4.
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    FIGURE 4.

    Polar map demonstrating regional myocardial thickening (A) and wall motion (B). Arrows highlight areas of decreased perfusion and denervation in distal left anterior descending region that show both thickening and motion. Septal paradoxic motion can be appreciated, and inferior and inferolateral hypokinesia is also apparent.

Tables

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    TABLE 1

    NYHA and ACC/AHA Classifications for Heart Failure

    NYHA classificationACC/AHA classification
    DescriptionClassClassDescription
    —AHigh risk of developing heart failure but no functional or structural heart deficits
    No limitation and no symptoms from ordinary activityIBStructural heart deficit but no symptoms
    Mild limitation with activity and comfortable at rest or with mild exertionIICHeart failure symptoms due to underlying structural heart deficit with medical management
    Significant limitation with any activity and comfortable only at restIIICHeart failure symptoms due to underlying structural heart deficit with medical management
    Discomfort with any physical activity and symptoms occurring at restIVDAdvanced disease requiring hospitalization, transplant, or palliative care
    —
    • Arrows indicate potential directions of stage progression. Horizontal alignment indicates corresponding stages between the 2 classifications.

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    TABLE 2

    Global 123I-MIBG Quantitative Values from Various Studies

    InvestigatorParameterHealthy cohortHeart failure cohortP
    Matsuo et al. (25)LVEF (%)73 ± 731 ± 1<0.05
    Delayed H:M2.6 ± 0.31.8 ± 0.9<0.05
    Washout (%)28 ± 338 ± 3<0.05
    Zhao et al. (26)LVEF (%)71.0 ± 11.222.0 ± 8.4—
    Delayed H:M2.66 ± 0.211.73 ± 0.39—
    Washout (%)11.88 ± 7.2331.58 ± 11.18—
    Bengel et al. (27)Delayed H:M2.8 ± 0.552.36 ± 0.660.04
    Washout (%)0.2 ± 10.211.6 ± 7.90.002
    • Data are mean ± SD.

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    TABLE 3

    H:M and Washout Rates for Optimistic and Pessimistic Approaches to Region-of-Interest Placement

    ParameterWhole heart/upper mediastinumWhole heart/lower mediastinumRegional heart/upper mediastinumRegional heart/lower mediastinum
    Early H:M2.151.662.652.05
    Delayed H:M2.211.652.551.90
    Heart Washout34.2%34.2%38.3%38.3%
    • Tabulated data show some variability; however, best and worst cases are consistent with low-risk H:M and abnormal washout.

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    TABLE 4

    Regional Analysis on SPECT

    ParameterUptake indexRegional washout rate (%)Washout index (uptake index)
    Early anterior1.6740.9%0.93
    Delayed anterior1.79
    Early lateral0.8533.9%0.83
    Delayed lateral1.02
    Early inferior0.5856.9%1.29
    Delayed inferior0.45
    Early septal1.4734.1%0.84
    Delayed septal1.76
    Early apical1.0246.2%1.02
    Delayed apical1.00
    • View popup
    TABLE 5

    Regional 123I-MIBG Parameters Determined by Zhao et al. (26) Using SPECT

    ParameterHealthy cohortHeart failure cohort
    LVEF (%)54.6 ± 17.716.8 ± 9.6
    Delayed MUP2.12 ± 0.361.23 ± 0.52
    Washout (%)1.04 ± 16.838.18 ± 18.52
    • MUP = uptake index.

    • Data are mean ± SD.

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Journal of Nuclear Medicine Technology: 39 (4)
Journal of Nuclear Medicine Technology
Vol. 39, Issue 4
December 1, 2011
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Risk Stratification in Heart Failure Using 123I-MIBG
Geoffrey M. Currie, Basit Iqbal, Janelle M. Wheat, Lexin Wang, Marko Trifunovic, Herbert F. Jelinek, Hosen Kiat
Journal of Nuclear Medicine Technology Dec 2011, 39 (4) 295-301; DOI: 10.2967/jnmt.111.088369

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Risk Stratification in Heart Failure Using 123I-MIBG
Geoffrey M. Currie, Basit Iqbal, Janelle M. Wheat, Lexin Wang, Marko Trifunovic, Herbert F. Jelinek, Hosen Kiat
Journal of Nuclear Medicine Technology Dec 2011, 39 (4) 295-301; DOI: 10.2967/jnmt.111.088369
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  • Article
    • Abstract
    • HEART FAILURE
    • CARDIAC AUTONOMIC NEUROPATHY IN HEART FAILURE
    • 123I-MIBG IN HEART FAILURE
    • CLINICAL CASE
    • DISCUSSION
    • CONCLUSION
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